A unique trauma-informed sexual health support for survivors of sexual violence

In Scotland, My Body Back has been providing a unique sexual health service for survivors of sexual violence since 2018. Its trauma-informed approach has succeeded in removing common barriers for survivors of sexual violence who need to access smear tests and other sexual health support. In this interview, Dr Alyson Welsh, Joint Clinical Lead of MBB tells us about how this innovative project has addressed a gap for survivors.
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Can you tell us a bit about you?
I have worked as a Specialty Doctor in Sexual Health for NHS Lanarkshire for 13 years, having previously worked as a General Practitioner while serving in the Royal Army Medical Corps. My current role involves a mix of contraception and GU medicine clinics, alongside psychosexual counselling. I also work as a Sexual Offences Examiner for Archway, Glasgow, as well as my role within the My Body Back service.

What is the My Body Back project and why was it created?
My Body Back is a dedicated service offering cervical screening to those who have experienced sexual violence. Contraception and sexual health screening can also be accessed, but the primary reason for attendance is cervical screening. MBB Glasgow is inspired by the original MBB project in London.

MBB was created by Pavan Amara who drew on her own difficulties in accessing healthcare after experiencing sexual violence, particularly surrounding being invited for a smear.​ It started life as a website and discussion forum which highlighted many people experiencing similar difficulties. A specialist clinic was established and opened in 2015, ​to provide women with “cervical screening, STI testing and contraceptive care in an environment tailored to their comfort and empowerment”.

MBB Glasgow was launched in 2018 and is staffed by doctors, nurses and counsellors employed by NHS GGC, Lanarkshire, Ayrshire and Arran, and Dumfries and Galloway. Although the project is housed in Sandyford in Glasgow, it is open to anyone in Scotland who has experienced sexual violence and who has been invited for, or is overdue for cervical screening.

Why did you become involved with the project?
I have been involved in the project since its inception in 2018 when staff working in sexual health were invited to apply, if interested. I was aware of the difficulties some people face surrounding intimate examination, and cervical screening in particular, and felt this was a very worthwhile and much needed service. Having worked in General Practice, as well as sexual health, I was also aware of the limitations in these settings in terms of the time and support that can be offered.

What are some of the barriers that survivors of sexual violence face when accessing sexual health services?
MBB is primarily a cervical screening service but contraception and sexual health testing can be accessed if required. The barriers to accessing sexual health services and cervical screening are very similar. Some are related to the process of making and attending appointments and some to the procedure itself. For a lot of people, they are unsure how they will feel and react to having an intimate examination after sexual violence, and may not feel like their GP practice or local clinic has the privacy, time or space to accommodate this. For others, they may not wish to disclose previous sexual violence to their GP practice or local service. In terms of the procedure itself, people report pain, being reminded of the previous assault, not feeling safe or in control, previous negative experience of smear, embarrassment and dislike of being touched.

How does My Body Back address those barriers?
As a dedicated clinic for those who have experienced sexual violence, there is no need for explicit disclosure. While people may be asked in a clinic to identify any triggers they may have, or modifications required to make the process more comfortable for them, they need not disclose any details of any previous violence. Each appointment is an hour long and begins with discussion with a counsellor and ends with further discussion with a counsellor if required. We have a dedicated space at Sandyford and, as the clinic is on a Saturday, often have sole use of the premises meaning a quiet, private space which includes the waiting area. An initial questionnaire is completed with the counsellor to identify any potential triggers and then discussed with the clinician. Clinicians are experienced, trauma-informed practitioners who are able to adapt and accommodate the individual’s requirements.
At MBB you take a trauma-informed approach to sexual health support, what does that look like in practice?
There are five key principles of trauma informed practice as outlined by the Scottish Government:

Safety
Efforts are made by an organisation to ensure the physical and emotional safety of clients and staff. This includes reasonable freedom from threat or harm, and attempts to prevent further re-traumatisation. ​
Trustworthiness ​
Transparency exists in an organisation's policies and procedures, with the objective of building trust among staff, clients and the wider community. ​
Choice ​
Clients and staff have meaningful choice and a voice in the decision-making process of the organisation and its services. ​
Collaboration ​
The organisation recognises the value of staff and clients' experience in overcoming challenges and improving the system as a whole. This is often operationalised through the formal or informal use of peer support and mutual self-help. ​
Empowerment ​
Efforts are made by the organisation to share power and give clients and staff a strong voice in decision-making, at both individual and organisational levels. ​
 
In practice, this means ensuring these principles are incorporated throughout the person’s journey through the service. Safety, trustworthiness and empowerment are at the core of how the clinic is set up and also in its aims. From the quiet, designated space, to the time spent in discussion and collaboration both before and during the clinic visit, these principles are adhered to. Questionnaires are completed at the beginning and end of each consultation in order to allow clients to have a voice in decision making and service improvement.

Ultimately, the whole journey is taken at the pace of the client. There is no pressure to proceed with a smear on the day of attendance and an examination can be stopped at any point in the process.
 
How was this trauma-informed approach developed and embedded at MBB?
In 2016, NHS Education Scotland was asked by the Scottish Government to develop resources to promote trauma informed practice, and the Scottish trauma informed practice toolkit was published in March 2021. As MBB began in 2018, the service has operated in a time where resources and understanding of what being trauma informed looks like in practice has now been formalised. This training has been adopted by the service and all staff have completed the formal training package from NES.  A lot of what we were doing instinctively, now has a framework in which to operate and that can be used to evaluate our practice.
 
What are some of the benefits of having a service like My Body Back for survivors?
There are benefits of the service for both clients and staff. As a practitioner, lessons learned from my sessions working in MBB have helped shape my approach to dealing with patients in all of my other roles, and I know this is the case for many of my colleagues. For some of those using the service it really can be about being able to achieve what they once considered unachievable.
 
What would you tell workers in any type of service who are developing their trauma-informed practice?
In my experience as a practitioner, the things that can make a huge difference to people can be small and easy to implement. Time, patience, understanding, listening and being able to adapt to each person’s unique needs can all make a huge impact. At a service level, an appreciation of the prevalence of trauma allows an understanding of how important this issue is. As I mentioned previously, there is now a government toolkit that can be used as a starting point.
 
How would you see MBB’s approach being expanding across Scotland?
Ideally, local provision of a service based on the MBB format would be better for clients. We have had people travel from all over Scotland but recognise that this creates a logistical and financial barrier to some. Ultimately, a truly trauma informed workforce and organisation would mean that dedicated clinics may not be necessary but, until then, I hope the MBB project continues to grow, flourish and share its approach with others.